Localization and operative management of undescended parathyroid adenomas in patients with persistent primary hyperparathyroidism

Kevin G. Billingsley, Douglas L. Fraker, John L. Doppman, Jeffrey A. Norton, Thomas H. Shawker, Monica C. Skarulis, Stephen J. Marx, Allen M. Spiegel, H. Richard Alexander

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background. Between 5% and 10% of patients who undergo cervical exploration for primary hyperparathyroidism will have persistent or recurrent hyperparathyroidism. Many of these patients have parathyroid tumors in unusual locations. One such site of ectopic parathyroid tissue is an undescended parathyroid adenoma at or superior to the carotid bifurcation. We describe our experience with the preoperative localization and surgical management of undescended parathyroid adenomas. Methods. From 1982 to 1993 a consecutive series of 2,55 patients have undergone localization studies and surgical exploration for persistent or recurrent hyperparathyroidism at the Clinical Center of the National Institutes of Health. Operative strategy was determined by review of the patient's surgical history, disease reports, and data from localizing studies. Patients with an underscended parathyroid adenoma identified before the operation were examined with a direct approach high in the neck. Patients who did not have definitive preoperative localization were explored with the previous transverse cervical incision. Results. Seventeen undescended parathyroid adenomas were identified in 255 patients. Thirteen (76%) of 17 patients had an undescended parathyroid adenoma precisely localized before the operation and were examined via a limited, oblique incision high in the neck anterior to the sternocleidomastoid muscle. In the 13 patients who had undergone accurate localization before the operation, the median operative lime was 75 minutes compared with 235 minutes for four patients who did not have an undescended parathyroid adenoma identified before the operation and were examined via a previous transverse cervical incision. All patients were cured of their hyperparathyroidism. Conclusions. Undescended parathyroid adenomas were the cause of failed cervical exploration in 17 (7%) of 255 patients, Accurate preoperative localization of these lesions is possible in most cases with a combination of noninvasive and invasive modalities. Successful preoperative localization can convert a prolonged exploration of the neck and mediastinum into a brief, curative procedure with minimal morbidity.

Original languageEnglish (US)
Pages (from-to)982-990
Number of pages9
JournalSurgery
Volume116
Issue number6
StatePublished - 1994
Externally publishedYes

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Parathyroid Neoplasms
Primary Hyperparathyroidism
Hyperparathyroidism
Neck
Choristoma
National Institutes of Health (U.S.)
Mediastinum
History

ASJC Scopus subject areas

  • Surgery

Cite this

Billingsley, K. G., Fraker, D. L., Doppman, J. L., Norton, J. A., Shawker, T. H., Skarulis, M. C., ... Alexander, H. R. (1994). Localization and operative management of undescended parathyroid adenomas in patients with persistent primary hyperparathyroidism. Surgery, 116(6), 982-990.

Localization and operative management of undescended parathyroid adenomas in patients with persistent primary hyperparathyroidism. / Billingsley, Kevin G.; Fraker, Douglas L.; Doppman, John L.; Norton, Jeffrey A.; Shawker, Thomas H.; Skarulis, Monica C.; Marx, Stephen J.; Spiegel, Allen M.; Alexander, H. Richard.

In: Surgery, Vol. 116, No. 6, 1994, p. 982-990.

Research output: Contribution to journalArticle

Billingsley, KG, Fraker, DL, Doppman, JL, Norton, JA, Shawker, TH, Skarulis, MC, Marx, SJ, Spiegel, AM & Alexander, HR 1994, 'Localization and operative management of undescended parathyroid adenomas in patients with persistent primary hyperparathyroidism', Surgery, vol. 116, no. 6, pp. 982-990.
Billingsley KG, Fraker DL, Doppman JL, Norton JA, Shawker TH, Skarulis MC et al. Localization and operative management of undescended parathyroid adenomas in patients with persistent primary hyperparathyroidism. Surgery. 1994;116(6):982-990.
Billingsley, Kevin G. ; Fraker, Douglas L. ; Doppman, John L. ; Norton, Jeffrey A. ; Shawker, Thomas H. ; Skarulis, Monica C. ; Marx, Stephen J. ; Spiegel, Allen M. ; Alexander, H. Richard. / Localization and operative management of undescended parathyroid adenomas in patients with persistent primary hyperparathyroidism. In: Surgery. 1994 ; Vol. 116, No. 6. pp. 982-990.
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abstract = "Background. Between 5{\%} and 10{\%} of patients who undergo cervical exploration for primary hyperparathyroidism will have persistent or recurrent hyperparathyroidism. Many of these patients have parathyroid tumors in unusual locations. One such site of ectopic parathyroid tissue is an undescended parathyroid adenoma at or superior to the carotid bifurcation. We describe our experience with the preoperative localization and surgical management of undescended parathyroid adenomas. Methods. From 1982 to 1993 a consecutive series of 2,55 patients have undergone localization studies and surgical exploration for persistent or recurrent hyperparathyroidism at the Clinical Center of the National Institutes of Health. Operative strategy was determined by review of the patient's surgical history, disease reports, and data from localizing studies. Patients with an underscended parathyroid adenoma identified before the operation were examined with a direct approach high in the neck. Patients who did not have definitive preoperative localization were explored with the previous transverse cervical incision. Results. Seventeen undescended parathyroid adenomas were identified in 255 patients. Thirteen (76{\%}) of 17 patients had an undescended parathyroid adenoma precisely localized before the operation and were examined via a limited, oblique incision high in the neck anterior to the sternocleidomastoid muscle. In the 13 patients who had undergone accurate localization before the operation, the median operative lime was 75 minutes compared with 235 minutes for four patients who did not have an undescended parathyroid adenoma identified before the operation and were examined via a previous transverse cervical incision. All patients were cured of their hyperparathyroidism. Conclusions. Undescended parathyroid adenomas were the cause of failed cervical exploration in 17 (7{\%}) of 255 patients, Accurate preoperative localization of these lesions is possible in most cases with a combination of noninvasive and invasive modalities. Successful preoperative localization can convert a prolonged exploration of the neck and mediastinum into a brief, curative procedure with minimal morbidity.",
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T1 - Localization and operative management of undescended parathyroid adenomas in patients with persistent primary hyperparathyroidism

AU - Billingsley, Kevin G.

AU - Fraker, Douglas L.

AU - Doppman, John L.

AU - Norton, Jeffrey A.

AU - Shawker, Thomas H.

AU - Skarulis, Monica C.

AU - Marx, Stephen J.

AU - Spiegel, Allen M.

AU - Alexander, H. Richard

PY - 1994

Y1 - 1994

N2 - Background. Between 5% and 10% of patients who undergo cervical exploration for primary hyperparathyroidism will have persistent or recurrent hyperparathyroidism. Many of these patients have parathyroid tumors in unusual locations. One such site of ectopic parathyroid tissue is an undescended parathyroid adenoma at or superior to the carotid bifurcation. We describe our experience with the preoperative localization and surgical management of undescended parathyroid adenomas. Methods. From 1982 to 1993 a consecutive series of 2,55 patients have undergone localization studies and surgical exploration for persistent or recurrent hyperparathyroidism at the Clinical Center of the National Institutes of Health. Operative strategy was determined by review of the patient's surgical history, disease reports, and data from localizing studies. Patients with an underscended parathyroid adenoma identified before the operation were examined with a direct approach high in the neck. Patients who did not have definitive preoperative localization were explored with the previous transverse cervical incision. Results. Seventeen undescended parathyroid adenomas were identified in 255 patients. Thirteen (76%) of 17 patients had an undescended parathyroid adenoma precisely localized before the operation and were examined via a limited, oblique incision high in the neck anterior to the sternocleidomastoid muscle. In the 13 patients who had undergone accurate localization before the operation, the median operative lime was 75 minutes compared with 235 minutes for four patients who did not have an undescended parathyroid adenoma identified before the operation and were examined via a previous transverse cervical incision. All patients were cured of their hyperparathyroidism. Conclusions. Undescended parathyroid adenomas were the cause of failed cervical exploration in 17 (7%) of 255 patients, Accurate preoperative localization of these lesions is possible in most cases with a combination of noninvasive and invasive modalities. Successful preoperative localization can convert a prolonged exploration of the neck and mediastinum into a brief, curative procedure with minimal morbidity.

AB - Background. Between 5% and 10% of patients who undergo cervical exploration for primary hyperparathyroidism will have persistent or recurrent hyperparathyroidism. Many of these patients have parathyroid tumors in unusual locations. One such site of ectopic parathyroid tissue is an undescended parathyroid adenoma at or superior to the carotid bifurcation. We describe our experience with the preoperative localization and surgical management of undescended parathyroid adenomas. Methods. From 1982 to 1993 a consecutive series of 2,55 patients have undergone localization studies and surgical exploration for persistent or recurrent hyperparathyroidism at the Clinical Center of the National Institutes of Health. Operative strategy was determined by review of the patient's surgical history, disease reports, and data from localizing studies. Patients with an underscended parathyroid adenoma identified before the operation were examined with a direct approach high in the neck. Patients who did not have definitive preoperative localization were explored with the previous transverse cervical incision. Results. Seventeen undescended parathyroid adenomas were identified in 255 patients. Thirteen (76%) of 17 patients had an undescended parathyroid adenoma precisely localized before the operation and were examined via a limited, oblique incision high in the neck anterior to the sternocleidomastoid muscle. In the 13 patients who had undergone accurate localization before the operation, the median operative lime was 75 minutes compared with 235 minutes for four patients who did not have an undescended parathyroid adenoma identified before the operation and were examined via a previous transverse cervical incision. All patients were cured of their hyperparathyroidism. Conclusions. Undescended parathyroid adenomas were the cause of failed cervical exploration in 17 (7%) of 255 patients, Accurate preoperative localization of these lesions is possible in most cases with a combination of noninvasive and invasive modalities. Successful preoperative localization can convert a prolonged exploration of the neck and mediastinum into a brief, curative procedure with minimal morbidity.

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